Dil ve Konuşma Terapistlerinin Disfajili Hastalarda Oral Beslenmeden Oral Olmayan Beslenmeye Geçiş Kararını Etkileyen Faktörlerin Araştırılması: Nitel Bir Çalışma

Abstract

Amaç: Oral beslenme disfajili hasta için yaşamsal bir risk oluşturduğunda veya hastanın besin alımı yetersiz olduğunda, farklı alternatif beslenme yöntemlerinin kullanımına ilişkin kararı dil ve konuşma terapistleri belirler. Bu önemli karar disfajili hastaların yaşamlarını fizyolojik, psikolojik ve sosyal açılardan etkilemektedir. Dil ve konuşma terapistlerinin karar mekanizmaları, hastanın tıbbi durumunu ve değerlendirme sonuçlarını içerir. Bu çalışma, dil ve konuşma terapistlerinin oral beslenmeden oral olmayan (non-oral) beslenmeye geçiş kararını etkileyen faktörleri araştırmayı amaçlamaktadır. Gereç ve Yöntemler: Çalışmamız fenomenolojik desende yapılmıştır. Yarı yapılandırılmış görüşmelere disfajili hastalarla çalışma deneyimi olan 9 dil ve konuşma terapisti katılmıştır. Veriler tematik analiz yaklaşımı kullanılarak MAXQDA programında kodlanmıştır. Bulgular: Altı ana tema oluşturulmuştur. Katılımcılar, hastaların medikal durumlarının ve yapılan değerlendirmelerin ve tedavilerin yanı sıra hasta ve yakınlarının tepkilerine, kararlarını hastaya açıklama anlarına, diğer profesyonellerle etkileşimlerine, çalışma ortamlarına, deneyimlerine ve eğitimlerine önem verdiklerini ifade etmişlerdir. Sonuç: Dil ve konuşma terapistlerinin beslenmeye ilişkin karar mekanizmalarını hastanın mevcut fizyolojik durumu kadar hasta yakınları, terapistin bireysel yaklaşımları, diğer profesyonellerle iletişim, değerlendirme süreci ve tedavi uygulaması gibi faktörler de etkilemektedir. Dil ve konuşma terapistleri tarafından verilen non-oral beslenme kararları da klinik deneyimleri ve eğitim geçmişleriyle bağlantılıdır. Dil ve konuşma terapistlerinin besleme geçişleri konusunda çok boyutlu düşünmeleri ve karar süreçlerine kritik önem vermeleri önerilir.

Keywords

• non oral beslenme
• disfaji
• dil ve konuşma terapisti
• fenomonolojik çalışma

Exploring the Factors Affecting Speech and Language Pathologists’ Decision to Transition from Oral to Non-Oral Feeding in Patients with Dysphagia: A Qualitative Study

Abstract

Aim: Speech and language pathologists (SLP) make decisions regarding the use of alternative feeding methods when oral feeding presents a vital risk for the dysphagia patients or when the patient’s food intake is deficient. This decision affects the lives of patients from physiological, psychological, and social aspects. The decision mechanisms of SLPs involve the medical status of the patient and evaluation results. This study aims to explore factors influencing the decision of SLPs to transition from oral to non-oral feeding. Material and Methods: Our study was conducted with a phenomenological design. Nine SLPs who had experience working with dysphagia patients participated in semi-structured interviews. Data were coded on the MAXQDA program using a thematic analysis approach. Results: Six main themes were constructed. In addition to the medical status of the patients, participants described giving importance to the reactions of patients and relatives, the moment of explaining their decision to the patient, interactions with other professionals, work environments, experiences and educational backgrounds, and the assessments and therapies patients underwent. Conclusion: The decision mechanisms of SLPs regarding feeding are not only affected by the physiological condition of the patient, but also by factors regarding patient relatives, the SLP’s personal approaches, communication with other professionals, the assessment process, and therapy implementation. Non-oral feeding decisions are also linked to their clinical experience and educational backgrounds. It is recommended that SLPs think multi-dimensionally about feeding transitions and give critical importance to their decision processes.

Keywords

• non-oral feeding
• dysphagia
• speech and language pathologist
• phenomenological study

References

1. Davis LA, Conti GJ. Speech-language pathologists' roles and knowledge levels related to non-oral feeding. J Med Speech-Lang Pa. 2003; 11(1): 15-31.
2. Phillips NM. Nasogastric tubes: An historical context. Medsurg Nurs. 2006; 15(2): 84-8.
3. Gauderer, MWL. Percutaneous endoscopic gastrostomy and the evolution of contemporary long-term enteral access. Clin Nutr. 2002; 21(2): 103-10. https://doi.org/10.1054/clnu.2001.0533
4. American Speech Language Hearing Association (ASHA). (2022, March 15). Alternative Nutrition and Hydration in Dysphagia Care. [Accessed: 2022 March 15]. Available from: https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/alternative-nutrition-and-hydration-in-dysphagia-care/
5. Ojo O, Keaveney E, Wang XH, Feng, P. The effect of enteral tube feeding on patients’ health-related quality of life: A systematic review. Nutrients. 2019; 11(5): 1046. https://doi.org/10.3390/nu11051046
6. Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, et al. ESPEN guideline on home enteral nutrition. Clin Nutr. 2020; 39(1): 5-22. https://doi.org/10.1016/j.clnu.2019.04.022
7. Neumeier AT, Moss M. We need an additional seat at the critical care multidisciplinary team table for our speech-language pathologists. Ann. Am. Thorac. Soc. 2014; 11(10): 1610-1.
8. Colodny N. Dysphagic independent feeders’ justifications for noncompliance with recommendations by a speech-language pathologist. Am J Speech Lang Pathol. 2005; 14(1): 61-70. https://doi.org/10.1044/1058-0360(2005/008)

9. Horner J, Modayil M, Chapman LR, Dinh A. Consent, refusal, and waivers in patient-centered dysphagia care: using law, ethics, and evidence to guide clinical practice. Am J Speech Lang Pathol. 2016; 25(4): 453-69. https://doi.org/10.1044/2016_AJSLP-15-0041
10. Logemann, JA. Role of the modified barium swallow in management of patients with dysphagia. Otolaryngol Head Neck Surg. 1997; 116(3): 335-8.
11. Tippett DC. Clinical challenges in the evaluation and treatment of individuals with poststroke dysphagia. Top Stroke Rehabil. 2011; 18(2): 120-33.
12. Martin-Harris, B, Brodsky, MB, Michel, Y, Ford, CL, Walters, B, Heffner, J. Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg. 2005; 131(9): 762-70. https://doi.org/10.1001/archotol.131.9.762
13. Garand KL, McCullough G, Crary M, Arvedson JC, Dodrill P. Assessment across the life span: The clinical swallow evaluation. Am J Speech Lang Pathol. 2020; 29(2S): 919-33. https://doi.org/10.1044/2020_AJSLP-19-00063
14. Sharp HM, Bryant KN. Ethical issues in dysphagia: When patients refuse assessment or treatment. Semin. Speech Lang. 2003; 24(4): 285-99.
15. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6): 349-57. https://doi.org/10.1093/ intqhc/mzm042
16. Lincoln YS, Guba EG. Naturalistic inquiry. Sage; 1985. https://doi.org/10.1016/0147-1767(85)90062-8.
17. Creswell JW. Mixed-method research: Introduction and application. In Handbook of educational policy (pp. 455-472). Academic press; 1999.
18. Kuckartz U, Radiker S. Analyzing qualitative data with MAXQDA. Switzerland: Springer International Publishing; 2019.
19. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual. Res. Sport Exerc. Health. 2019; 11(4): 589-97. https://doi.org/10.1080/2159676X.2019.1628806.
20. Rubin HJ, Rubin IS. Qualitative interviewing: The art of hearing data (3rd ed.). Thousand Oaks: Sage; 2012.
21. Robinson A, Coxon K, McRae J, Calestani M. Family carers’ experiences of dysphagia after a stroke: An exploratory study of spouses living in a large metropolitan city. Int J Lang Commun Disord. 2022; 57(5): 924-36. https://doi.org/10.1111/1460-6984.12733
22. Kelly K, Cumming S, Kenny B, Smith-Merry J, Bogaardt H. Getting comfortable with “comfort feeding”: An exploration of legal and ethical aspects of the Australian speech-language pathologist’s role in palliative dysphagia care. Int. J. Speech-Lang. Pathol. 2018; 20(3): 371-9.
23. King JM, Ligman K. Patient noncompliance with swallowing recommendations: reports from speech-language pathologists. Contemp Issues Commun Sci Disord. 2011; 38(Spring): 53-60.
24. Kenny B. Food culture, preferences and ethics in dysphagia management. Bioethics. 2015; 29(9): 646-52.
25. Braun UK, Rabeneck L, McCullough LB, Urbauer DL, Wray NP, Lairson DR, et al. Decreasing use of percutaneous endoscopic gastrostomy tube feeding for veterans with dementia: Racial differences remain. J Am Geriatr Soc. 2005; 53(2): 242-8. https://doi.org/10.1111/j.1532-5415.2005.53109.x
26. Gordon, M, Alibhai SHH. Ethics of PEG tubes: Jewish and Islamic perspectives. Am J Gastroenterol. 2004; 99(6): 1194.
27. Daniels SK, Schroeder, MF, DeGeorge, PC, Corey, DM, Foundas, AL, Rosenbek, JC. Defining and measuring dysphagia following stroke. Am J Speech Lang Pathol. 2009; 18(1): 74-81.
28. Howells SR, Cornwell PL, Ward EC, Kuipers P. Dysphagia care for adults in the community setting commands a different approach: perspectives of speech–language therapists. Int J Lang Commun Disord. 2019; 54(6): 971-81.